Endometrium with squamous morules
| Endometrium with squamous morules | |
|---|---|
| Diagnosis in short | |
 Squamous morule. H&E stain. | |
|
| |
| LM | well-circumscribed ball of squamoid cells -- cells have a whorled arrangement, moderate eosinophilic cytoplasm and a bland nucleus |
| LM DDx | endometrial hyperplasia, endometrial carcinoma - esp. endometrioid endometrial carcinoma, uterine leiomyoma, atypical polypoid adenomyoma |
| Gross | +/-endometrial thickening |
| Site | endometrium |
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| |
| Associated Dx | endometrial hyperplasia, endometrial carcinoma - esp. endometrioid endometrial carcinoma |
| Prognosis | benign in itself, strong assoc. with malignancy |
- Squamous morules redirects here.
Endometrium with squamous morules is important to recognize as squamous morules are strongly associated with malignancy.
General
- Benign finding in itself.
- Strong association with malignancy.[1]
- Associated with glandular lesions, i.e. endometrial hyperplasia and adenocarcinoma, not neoplastic squamous lesions.[2]
Microscopic
Features:
- Well-circumscribed ball of squamoid cells:
- Cells have a whorled arrangement.
- Moderate eosinophilic cytoplasm.
- Bland nucleus.
- Smooth nuclear membrane.
- Pale nuclear staining.
- Fine chromatin pattern.
DDx:
- Complex endometrial hyperplasia with or without atypia.
- Endometrioid endometrial carcinoma.
- Uterine leiomyoma.
- Atypical polypoid adenomyoma - squamous morules and proliferation of smooth muscle.
Images
SM - intermed. mag.
SM - high mag.
SM - high mag.
SM - high mag.
SM - very high mag.
SM - extremely high mag.
www:
IHC
Features:[2]
- ER -ve.
- PR -ve.
- Ki-67 low.
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ENDOMETRIUM, BIOPSY: - PROLIFERATIVE PHASE ENDOMETRIUM WITH A FOCUS OF SQUAMOUS MORULES, SEE COMMENT. COMMENT: There is no evidence of hyperplasia or malignancy in this biopsy; however, squamous morules are associated with hyperplasia and malignancy. Close follow-up and a re-biopsy (when clinically indicated) are recommended.
ENDOMETRIUM, BIOPSY: - EXTENSIVELY FRAGMENTED ENDOMETRIUM WITH ABUNDANT SQUAMOUS MORULES, SEE COMMENT. - FOCAL STROMAL CONDENSATION SUGGESTIVE OF SHEDDING. COMMENT: The fragmentation makes it difficult to assess for hyperplasia. The squamous morules have degenerative changes centrally. There is no evidence of malignancy in this biopsy. Squamous morules are associated with hyperplasia and malignancy. Close follow-up and a re-biopsy (when clinically indicated) are recommended.
See also
- Endometrium.
- Endometrial hyperplasia.
- Metaplasias of the endometrium.
- Endometrium with psammoma bodies.
References
- ↑ Nicolae, A.; Preda, O.; Nogales, FF. (Feb 2011). "Endometrial metaplasias and reactive changes: a spectrum of altered differentiation.". J Clin Pathol 64 (2): 97-106. doi:10.1136/jcp.2010.085555. PMID 21126963.
- ↑ 2.0 2.1 2.2 Lin, MC.; Lomo, L.; Baak, JP.; Eng, C.; Ince, TA.; Crum, CP.; Mutter, GL. (Feb 2009). "Squamous morules are functionally inert elements of premalignant endometrial neoplasia.". Mod Pathol 22 (2): 167-74. doi:10.1038/modpathol.2008.146. PMID 19180120.